Review Article High-quality nursing promotes postoperative recovery and complication reduction in patients undergoing anorectal surgery for ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Int J Clin Exp Med 2020;13(6):3841-3847 www.ijcem.com /ISSN:1940-5901/IJCEM0109882 Review Article High-quality nursing promotes postoperative recovery and complication reduction in patients undergoing anorectal surgery for hemorrhoids Guangrun Huang1*, Dongqin Liang3*, Yujie Hu4, Hongyan Yang2, Haiyan Li1, Dinggai Chu5, Junli Jia6 1 Department of Gastroenterology, 2Anesthesia Operating Room, Optical Valley Branch of Wuhan Third Hospital, Wuhan, Hubei Province, China; Departments of 3Neurosurgery, 4Hospital Infection Control, Dongxihu District People’s Hospital, Wuhan, Hubei Province, China; 5Department of Oncology and Rheumatology, Dongxihu District People’s Hospital, Wuhan, Hubei Province, China; 6Thoracic Surgery Bone & Soft Tissue Surgery in Hubei Cancer Hospital Tongji Medical College, Huazhong University of Science and Techology, Wuhan, Hubei Province, China. * Equal contributors and co-first authors. Received February 26, 2020; Accepted April 24, 2020; Epub June 15, 2020; Published June 30, 2020 Abstract: Objective: This study aimed to explore the application value of high-quality nursing (HQN) in patients with hemorrhoids after operation. Methods: Altogether 174 patients with hemorrhoids admitted to our hospital from August 2016 to August 2018 were enrolled as research subjects for prospective analysis. Eighty-four cases (observation group) were treated with HQN after admission, while the other 90 cases (control group) were treated with conventional nursing. They were compared with respect to the incidence of postoperative complications, pain score, and the time of first spontaneous gas and defecation after operation. Their nursing satisfaction was sur- veyed upon discharge, and their hospitalization time was recorded. They were followed up for prognosis for over one year through hospital reexamination. The 1-year recurrence of hemorrhoids was recorded and the recurrence rate was calculated. Results: Compared with those in the control group, patients in the observation group had lower incidence of complications and pain score (P
Application value of high-quality nursing in hemorrhoid surgery
Based on previous studies, nursing interven- Methods
tion can improve the postoperative situation of
tumor patients [12, 13], but there is no research Nursing for patients in the control group: Their
to confirm whether nursing methods have any vital signs were monitored. Whether there was
effect on the surgical treatment of patients hemorrhaging at the anastomotic stoma was
with hemorrhoids. High-quality nursing (HQN) is checked every day, and wound swelling was
a widely used nursing intervention in clinical treated. Patients with abnormal urination and
practice. Compared with traditional nursing, defecation were reported to the attending phy-
HQN better higher humanized nursing and sician in a timely manner and treated acco-
more detailed attention, and is especially suit- rdingly.
able for postoperative nursing. According to a
Nursing for patients in the observation group: A
previous study, the application of HQN has
treatment and nursing manual was made and
more significant clinical efficacy after the surgi-
distributed to the patients after admission. The
cal treatment of melanoma and other diseases
nursing staff introduced the hospital situation
[14]; so we speculate that its application to
and disease-related knowledge to patients,
anorectal surgery for hemorrhoids will also
and taught them the treatment plan of some
achieve significant results. However, there are
common problems during the treatment.
currently very few studies on the application of
Windows were opened every day for ventilation
HQN interventions for this type of surgery. In
to keep the wards comfortable. Preoperative
order to reduce the recurrence and complica-
local hot compress and warm salt baths were
tions of the patients, the application value of given to the patients for 20-30 min, with the
HQN in hemorrhoid surgery was explored in this temperature of 40-50°C. After the operation,
study, so as to provide reliable references for the patients were placed in a comfortable posi-
future clinical operations on patients. tion, where the pain was evaluated after anes-
thetics wore off. Different intervention mea-
Materials and methods
sures were carried out according to pain sever-
General information ity (the attention of patients with slight pain
could be diverted through communication and
A total of 174 patients with hemorrhoids admit- watching TV and playing music; patients with
ted to our hospital from August 2016 to August severe pain could take appropriate analgesic
2018 were selected as the research subjects drugs). Hot compress, acupuncture, and other
for prospective analysis. Inclusion criteria: modalities were performed to relieve the pain,
those diagnosed with hemorrhoids after ano- and the wound was cleaned regularly every day.
rectal examination in our hospital; those receiv- The patients were instructed urinate and to
ing hemorrhoid surgery after admission; those complete simple limb exercises every 5 hours.
aged 30-60 years; those with complete medi- If they still had no sense of spontaneous urina-
cal records; those willing to cooperate with the tion after 24 hours, they were given hot com-
investigation at our hospital. Exclusion criteria: press and massage. They were also instructed
those complicated with tumors; those compli- to eat more vegetables, light food, and semi-
cated with other cardiovascular and cerebro- liquid food, and introduced to any postopera-
vascular diseases; those complicated with tive actions that should be avoided as well as
successful treatment cases.
other infectious diseases; those complicated
with other autoimmune dysfunction; those with Outcome measures
failure of important organs; those complicated
with mental disorders; those who had received Major outcome measures
antibiotic therapy, chemotherapy, radiotherapy,
and surgery within half a year before admis- Incidence of postoperative complications: The
sion; pregnant and lactating women; those who complications after operation to discharge
had transferred to other hospitals. Eighty-four were recorded to calculate their incidence.
patients (observation group) were treated with Pain: Visual Analogue Scale (VAS) was used to
HQN after admission, while the other 90 assess patient pain before, 2 hours after, 1 day
patients (control group) were treated with con- after, and 3 days after operation. Scoring stan-
ventional nursing. dards (0-10 points scale) were as follows: 0
3842 Int J Clin Exp Med 2020;13(6):3841-3847
Application value of high-quality nursing in hemorrhoid surgery
Table 1. Comparison of general information [n (%)] Figure 1. Comparison of VAS score. *
indicates PApplication value of high-quality nursing in hemorrhoid surgery
Figure 3. Comparison of nursing satisfaction score.
The nursing satisfaction score in the observation
group was higher than that in the control group. *
indicates P
0.050). See Table 1.
Comparison of incidence of complications
The incidence of complications in the observa-
tion group (7.14%) was lower than that in the
control group (20.00%) (P=0.014). See Table 2.
Figure 2. Comparison of excretion. A. The time of
Comparison of pain score
postoperative gas in the observation group was
shorter than that in the control group. * indicates
PApplication value of high-quality nursing in hemorrhoid surgery
Table 3. Comparison of nursing satisfaction [n (%)] Discussion
Observation Control
χ2 P At present, hemorrhoids have an in-
group (n=84) group (n=90)
Satisfied 69 (82.14) 59 (65.56) 6.147 0.013 creasing incidence and cause increas-
Generally satisfied 11 (13.10) 18 (20.00) 1.491 0.222 ingly serious harm to patients [15]. The
Dissatisfied 4 (4.76) 13 (14.44) 4.621 0.032 disease may be caused by long-term
alcoholism, unhealthy diet, bad living
habits, sedentariness, and many other
reasons [16]. In clinical practice, the most
effective therapeutic method for it is surgical
treatment, which is not difficult but easily gives
rise to a series of postoperative complications
due to misoperation [17]. Moreover, postopera-
tive stress reactions are clear, leading to
extreme pain [18]. Previous studies have found
that nursing modes significantly relieve pain
caused by chronic diseases and cardiac sur-
gery [19, 20]. Therefore, the influence of HQN
on hemorrhoid surgery was explored in this
study, which is of great clinical significance.
In this study, the incidence of postoperative
complications in the observation group was
lower than that in the control group. This sug-
gests that HQN can reduce postoperative com-
Figure 4. Comparison of hospitalization time. The
hospitalization time in the observation group was plications of hemorrhoids, consistent with find-
shorter than that in the control group. * indicates ings of Murphy and others. They explored the
PApplication value of high-quality nursing in hemorrhoid surgery
Table 4. Comparison of recurrence rate tion in the observation group. Hospita-
Observation Control lization time in the observation group was
χ2 P significantly shorter than that in the con-
group (n=80) group (n=83)
Recurrence 5 (6.25) 15 (18.07) 5.289 0.022 trol group, further confirming that HQN
Non-recurrence 75 (93.75) 68 (93.75) can shorten the rehabilitation time of the
patients. According to the prognostic fol-
low-up, the 1-year recurrence rate of hem-
was significantly less than that in the control orrhoids in the observation group was signifi-
group. This shows that HQN can relieve the cantly lower than that in the control group,
postoperative pain of hemorrhoid surgery, which presumably was closely related to the
which may have two possible reasons. One is intervention of HQN. This nursing mode has
physiological intervention. Preoperative (hot greatly improved the therapeutic efficiency of
compress and warm salt bath) and postopera- patients with hemorrhoids through comprehen-
tive (acupuncture) methods fundamentally sive and targeted intervention, which has
relieves patients pain. The other is psychologi- proved its great clinical application prospects.
cal intervention. Preoperative communication
and postoperative attention transfer reduce However, this experiment still has some defi-
the degree of pain felt by patients. These two ciencies due to limited conditions. For instance,
reasons resulted in a significant difference in only conventional nursing was compared with
VAS score between the two groups. The score HQN in this study, so the differences between
in the two groups was the highest at 2 hours HQN and other nursing methods may not be
after operation, which was due to the gradual revealed. This will be analyzed as a key research
disappearance of anesthetic effect after opera- direction in the future. Moreover, we cannot
tion and the most significant trauma and stress judge the impact of HQN on the long-term prog-
caused by the operation. This reveals that pain nosis of patients because of the short examina-
intervention in patients with hemorrhoids sh- tion period, so we will conduct a longer follow-
ould be strengthened at 2 hours after opera- up investigation on the research subjects in
tion to improve their postoperative sensations. this study, so as to improve our conclusions.
The time of first postoperative gas and defeca-
tion in the observation group was shorter than Conclusion
that in the control group, which indicates that
HQN has a more significant improvement effect HQN can reduce the postoperative complica-
on the patients’ body function recovery. In addi- tions, pain, and recurrence rate of patients with
tion, the nursing satisfaction in the observation hemorrhoids, and improve their nursing satis-
group was significantly better than that in the faction, so it is worthy of promotion and appli-
control group, which also confirms the extreme- cation in clinical practice.
ly important effect of HQN. Some investigations
have pointed out that hospitalized patients Disclosure of conflict of interest
undergoing surgery generally have a great
degree of negative emotions due to their fear of None.
diseases and operations, their uneasiness of
Address correspondence to: Junli Jia, Thoracic
doctors, and their pain caused by diseases
Surgery Bone & Soft Tissue Surgery in Hubei Cancer
[24]. This kind of negative emotion may not only
affect the nursing of the patients by the medi- Hospital Tongji Medical College, Huazhong University
cal staff, but also affect patient recovery. of Science and Techology, No. 116 Zhuodaoquan
Therefore, eliminating the negative emotion is South Load, Hongshan District, Wuhan, Hubei Pro-
essential for improving nursing services. HQN vince, China. E-mail: xueheqiejiu95079@163.com
requires nursing staff to actively communicate
References
with patients and introduce the hospital situa-
tion and disease-related knowledge, so as to [1] Sandler RS and Peery AF. Rethinking what we
improve their understanding and learn to trust know about hemorrhoids. Clin Gastroenterol
the medical staff imperceptibly. In addition to Hepatol 2019; 17: 8-15.
helping patients reduce negative emotions, it [2] Mott T, Latimer K and Edwards C. Hemor-
can improve their feelings about nursing; which rhoids: diagnosis and treatment options. Am
is possibly the cause of higher nursing satisfac- Fam Physician 2018; 97: 172-179.
3846 Int J Clin Exp Med 2020;13(6):3841-3847Application value of high-quality nursing in hemorrhoid surgery
[3] Lin G, Ge Q, He X, Qi H and Xu L. A novel tech- [14] Wouters MW, Michielin O, Bastiaannet E, Beis-
nique for the treatment of stages III to IV hem- hon M, Catalano O, Del Marmol V, Delgado-
orrhoids: homemade anal cushion suspension Bolton R, Dendale R, Trill MD, Ferrari A, Forsea
clamp combined with harmonic scalpel. Medi- AM, Kreckel H, Lovey J, Luyten G, Massi D,
cine (Baltimore) 2017; 96: e7309. Mohr P, Oberst S, Pereira P, Prata JPP, Rut-
[4] Ram E, Bachar GN, Goldes Y, Joubran S and kowski P, Saarto T, Sheth S, Spurrier-Bernard
Rath-Wolfson L. Modified Doppler-guided laser G, Vuoristo MS, Costa A and Naredi P. ECCO
procedure for the treatment of second- and essential requirements for quality cancer care:
third-degree hemorrhoids. Laser Ther 2018; melanoma. Crit Rev Oncol Hematol 2018; 122:
27: 137-142. 164-178.
[5] Lin LH, Siu JJ, Liao PC, Chiang JH, Chou PC, [15] Garg P. Conservative treatment of hemor-
Chen HY, Ho TJ, Tsai MY, Chen YH and Chen rhoids deserves more attention in guidelines
WC. Association of chronic obstructive pulmo- and clinical practice. Dis Colon Rectum 2018;
nary disease and hemorrhoids: a nationwide 61: e348.
cohort study. Medicine (Baltimore) 2017; 96: [16] Idrees JJ, Clapp M, Brady JT, Stein SL, Reynolds
e6281. HL and Steinhagen E. Evaluating the accuracy
[6] Jacobs DO. Hemorrhoids: what are the options of hemorrhoids: comparison among special-
in 2018? Curr Opin Gastroenterol 2018; 34: ties and symptoms. Dis Colon Rectum 2019;
46-49. 62: 867-871.
[7] Davis BR, Lee-Kong SA, Migaly J, Feingold DL [17] Cengiz TB and Gorgun E. Hemorrhoids: a range
and Steele SR. The American Society of Colon of treatments. Cleve Clin J Med 2019; 86: 612-
and Rectal Surgeons Clinical Practice Guide- 620.
lines for the management of hemorrhoids. Dis [18] Chou A, Krukowski K, Jopson T, Zhu PJ, Costa-
Colon Rectum 2018; 61: 284-292.
Mattioli M, Walter P and Rosi S. Inhibition of
[8] Zhang G, Liang R, Wang J, Ke M, Chen Z, Huang
the integrated stress response reverses cogni-
J and Shi R. Network meta-analysis of random-
tive deficits after traumatic brain injury. Proc
ized controlled trials comparing the procedure
Natl Acad Sci U S A 2017; 114: E6420-E6426.
for prolapse and hemorrhoids, Milligan-Mor-
[19] Berube M, Gelinas C, Choiniere M, Feeley N,
gan hemorrhoidectomy and tissue-selecting
Martorella G, Parent S and Streiner DL. The ef-
therapy stapler in the treatment of grade III
fect of psychological interventions on the pre-
and IV internal hemorrhoids (Meta-analysis).
vention of chronic pain in adults: a systematic
Int J Surg 2020; 74: 53-60.
review protocol. Syst Rev 2017; 6: 190.
[9] Trenti L, Biondo S, Galvez A, Bravo A, Cabre-
ra J and Kreisler E. Distal Doppler-guided [20] Moghimian M, Akbari M, Moghaddasi J and
transanal hemorrhoidal dearterialization with Niknajad R. Effect of digital storytelling on anx-
mucopexy versus conventional hemorrhoidec- iety in patients who are candidates for open-
tomy for grade III and IV hemorrhoids: postop- heart surgery. J Cardiovasc Nurs 2019; 34:
erative morbidity and long-term outcomes. 231-235.
Tech Coloproctol 2017; 21: 337-344. [21] Murphy PB, Paskar D, Hilsden R, Koichopolos
[10] Lin HC, He QL, Shao WJ, Chen XL, Peng H, Xie J, Mele TS; Western Ontario Research Collab-
SK, Wang XX and Ren DL. Partial stapled hem- orative on Acute Care S. Acute care surgery: a
orrhoidopexy versus circumferential stapled means for providing cost-effective, quality care
hemorrhoidopexy for grade III to IV prolapsing for gallstone pancreatitis. World J Emerg Surg
hemorrhoids: a randomized, noninferiority tri- 2017; 12: 20.
al. Dis Colon Rectum 2019; 62: 223-233. [22] Margetis N. Pathophysiology of internal hemor-
[11] Iida Y, Saito H, Takashima Y, Saitou K and Mun- rhoids. Ann Gastroenterol 2019; 32: 264-272.
emoto Y. Procedure for prolapse and hemor- [23] Yoshikawa K, Kawashima R, Hirose Y, Shibata
rhoids (PPH) with low rectal anastomosis using K, Akasu T, Hagiwara N, Yokota T, Imai N, Iwaku
a PPH 03 stapler: low rate of recurrence and A, Kobayashi G, Kobayashi H, Kinoshita A,
postoperative complications. Int J Colorectal Fushiya N, Kijima H, Koike K and Saruta M.
Dis 2017; 32: 1687-1692. Liver injury after aluminum potassium sulfate
[12] Shi X, Yu S, Wang F, Zhao Q, Xu H and Li B. A and tannic acid treatment of hemorrhoids.
gastrointestinal stromal tumor with acute World J Gastroenterol 2017; 23: 5034-5040.
bleeding: management and nursing. Medicine [24] Jenkins LM, Andrewes DG, Nicholas CL, Drum-
(Baltimore) 2018; 97: e9874. mond KJ, Moffat BA, Phal PM and Desmond P.
[13] Cheung AT, Li WHC, Ho LLK, Ho KY, Chiu SY, Emotional reactivity following surgery to the
Chan CG and Chung OK. Impact of brain tumor prefrontal cortex. J Neuropsychol 2018; 12:
and its treatment on the physical and psycho- 120-141.
logical well-being, and quality of life amongst
pediatric brain tumor survivors. Eur J Oncol
Nurs 2019; 41: 104-109.
3847 Int J Clin Exp Med 2020;13(6):3841-3847You can also read
